When falling asleep at night becomes difficult, it’s easy to feel helpless or alone. In reality, insomnia affects 

 and can last anywhere from a few days to weeks, months, or longer.

Insomnia is a sleep disorder that impedes a person’s ability to fall or stay asleep, leading to low energy levels, mood changes, and an overall decreased quality of life. 

Feeling tired even after several hours of sleep

Difficulty to concentrate on, remember, or perform certain tasks

Most cases of insomnia are acute, which means each episode may only last for up to a few weeks – usually when the patient goes through a stressful period of time. About 10% of reported cases, however, may worsen, leading to longer periods of insomnia. If you have been experiencing at least three days of insomnia symptoms every week for the past month, your condition 

This leads us to an important question: Can insomnia be cured?

Insomnia can be addressed using a variety of treatment methods, depending on its severity. Even chronic insomnia can be cured entirely by addressing the underlying cause of the issue in many cases.  So, what are the options for curing insomnia?

Short term solutions for treating insomnia

Short term or “acute insomnia” can be tackled by 

 to promote better rest. These minor adjustments are often the first steps of treatment programs and can provide short-term relief:

: Refrain from drinking coffee, smoking, or drinking too much at night, as it can take at least a few hours for your body to process these substances.

: Designating a window of time to go to sleep and wake up at about the same hour, be it weekends or weekdays, will help your body get used to the routine.

Exercise is a universal treatment for all ailments, including insomnia! Exercising will also help increase your sleep drive; the consumption of energy leads to more of a need for sleep, as your body wants to recover.

 It’s challenging to go from full-on work mode into sleep mode. It’s important to have a buffer between the time you spend doing stimulating goal-oriented activities and sleep. Fill this time with things you enjoy but don’t require too much mental effort. Good examples are reading, watching a sitcom, yoga, or mindfulness.

The solutions mentioned above are, most of the time, only suited to treat acute insomnia. In chronic cases, addressing the underlying cause of the problem is a much more effective solution.

Insomnia may affect you both psychologically and physically, regardless of the cause of your sleep deprivation. People who experience insomnia have a worse quality of life than those who sleep well, often experiencing mood swings and potentially being predisposed to developing other health conditions.

While it may be tempting to resort to medication, keep in mind this only provides short-term relief, and getting to the root cause of the issue is the best way to cure insomnia for good. Numerous studies showed that CBT-I can be 

more effective than prescription medication

, with 75-80% of patients reporting significant improvements after CBT-I.

If insomnia decreases your ability to function properly throughout the day, you should consult a sleep professional to determine the potential causes of your sleeping issue—and how to treat them.

Cognitive Behavioral Therapy (CBT) is a form of talking therapy that focuses on how specific thinking patterns affect a person’s behavior and helps patients correct those “cognitive distortions” (inaccurate, negatively biased thoughts). This approach to therapy is used to treat numerous mental health disorders, including depression, anxiety, PTSD, and substance abuse.

CBT-I (Cognitive Behavioral Therapy for Insomnia) addresses the feelings, thoughts, or actions that contribute to insomnia, such as stressing over the fact that you don’t get enough sleep or that your lack of sleep may lead to health issues or other problems in your daily life. The objective of CBT-I is to help the patient eliminate the frustration and anxiety they experience during the process of going to bed, allowing them to enjoy night after night of effortless sleep.

Due to its non-invasive nature, CBT-I has proven very successful in treating insomnia, leading to sustaining 

improvement in both sleep latency and total sleep time

 is a safe, evidence-based program that employs CBT-I to restore your natural sleep ability. Dawn provides you with a tailored sleep plan, records your sleeping patterns, connects you with a sleep coach, and much more – all in accordance with requirements by the American Academy of Sleep Medicine.

If you are ready to explore long-term solutions to your sleeping issues, 

get started on the path to curing your insomnia for good

Wondering if your insomnia can be cured, or how to treat your insomnia? Learn all about insomnia and how to cure it with CBT-I today.

Can Insomnia Be Cured? Insomnia Symptoms & Treatment | Dawn Health

Can insomnia be cured?

Do you have difficulty falling asleep? Do you wake up in the middle of the night, unable to fall back asleep?

If that sounds like you, you may be struggling with sleep-onset insomnia. Not being able to fall asleep when you want to can be a huge source of frustration.

However, there is good news. Understanding what’s keeping you awake and the options for improving your sleep quality is the first step to putting insomnia to rest.

Some people lay down in bed and fall asleep minutes after turning off the light, while for others, falling asleep can be a longer struggle.

The time it takes to transition from being awake to entering a state of sleep is called

. Your sleep latency is an indicator of how healthy your sleep patterns are. Sleep latency depends on many different factors, and it is important to note that the occasional night where it takes longer to fall asleep is not necessarily significant. However, If you frequently experience that it takes you longer than 10 to 20 minutes to fall asleep, it can indicate an unhealthy sleep pattern, as adults with healthy sleep patterns typically fall asleep within 

Unhealthy sleep latency is a symptom of sleep-onset insomnia. Sleep-onset insomnia is the 

inability to sleep when one is ready to, at the beginning of the night

The struggle to fall asleep can be temporary (acute) or long-term (chronic). If not treated properly, acute insomnia 

 chronic. Chronic insomnia refers to difficulty sleeping that 

Everyone struggles to sleep from time to time, but if it becomes a pattern, you may be experiencing insomnia. In addition to difficulty falling asleep, symptoms of sleep-onset insomnia 

If you are consistently experiencing one or more of these symptoms, it may be time to consider speaking to your health care provider.

Several factors may contribute to sleep-onset insomnia. The Sleep Foundation lists 

According to the Centers for Disease Control and Prevention, adults need 

 per night to function optimally. Sleep-onset insomnia reduces total sleep time, which can have an impact on overall health.

Lack of sleep increases the risk of developing chronic health conditions, including diabetes, heart disease, obesity, and depression. Sleep deficits also 

increase the risk for accidents and decrease quality of life

Your health care provider can help you determine the cause of your insomnia and guide you to find the right course of treatment to return to getting a healthy, restful, consistent night’s sleep.

Medication that has a sedating effect may be used to treat sleep-onset insomnia by promoting drowsiness. The goal when using sleep medication should 

 be to return to a natural cycle of sleep and not create dependency on medication to achieve sleep.

Cognitive-Behavioral Therapy for Insomnia (CBT-I)

, “CBT-I focuses on exploring the connection between the way we think, the things we do, and how we sleep. During treatment, a trained CBT-I provider helps to identify thoughts, feelings, and behaviors that are contributing to the symptoms of insomnia.”

Learn strategies to challenge unhelpful thinking patterns.

Get help identifying and changing habits that stand in the way of a great night of sleep.

Understand how the connection between thoughts, feelings, behaviors, and sleep is central to CBT-I.

proven to work in numerous clinical trials and are more effective than medication

 of patients experience sustained improvement in sleep after CBT-I.

Start your journey to a restful night’s sleep!

 to learn more about how CBT-I can effectively treat your sleep onset insomnia and why working with the sleep coaches at 

Learn the definition of sleep latency, how unhealthy sleep latency may cause sleep-onset insomnia, and how to treat sleep-onset insomnia with Dawn!

Sleep Onset Insomnia: Definition, Symptoms, Treatment | Dawn Health

What is sleep-onset insomnia? 

A delicate balance between two opposing systems governs our body and mind 

. The sympathetic system is the body’s threat detection system that prepares your body to respond to any threat. On the other hand, the parasympathetic system calms the body and mind and induces a state of relaxation.

'Everything in life has to have balance.' - Donna Karan.

When the balance tilts in favor of the sympathetic system, hyperarousal ensues. A heightened threat detection system, though, comes at a cost.

Read on to learn what hyperarousal is, its symptoms and causes, how it affects your sleep, and what you can do about it.


Hyperarousal is defined as a state where you are more alert or vigilant. Usually, alertness is caused by the brain detecting a threat and entering fight-or-flight mode. The cause can be a real external threat or internal; for example, worrying about the consequences of not getting enough sleep. It is completely normal and something that we all experience from time to time.

The level of hyperarousal one can experience varies a lot, the most extreme being Post-Traumatic Stress Disorder (PTSD). Note that PTSD is not a normal state, and you do not have to have PTSD to experience hyperarousal. It can manifest itself as a subtle sense of unease that you might not even become aware of, but can still disrupt your sleep.

Hyperarousal is also used to describe other states where you feel emotions like curiosity, bewilderment, frustration, or anger.

The stimuli can be external, internal, physical or emotional, since your body cannot differentiate between the two. This leads to symptoms 

Sleep requires the body and mind to relax. It is predominantly a parasympathetic activity. But, in a hyperaroused state, 

the sympathetic system overpowers the parasympathetic one

. This makes evolutionary sense because sleeping when there is an imminent threat significantly lowers your chances of survival.

Being constantly on high alert can cause sleep to be delayed and rapid, anxious thoughts to occur at night. Further, inadequate sleep can then lead to more stress. Put differently; it is a 

Unfortunately, if stress is keeping you up at night, you are not alone. According to the National Sleep Foundation Survey, 

 have trouble sleeping due to stress every month. Even though you may have been struggling to sleep, you do not have to. Practical, simple treatments for hyperarousal insomnia 

. In other words, it is a mental state that triggers the body to react physically and mentally to thoughts and emotions. Fortunately, this mental state can be reversed.

Cognitive-behavioral therapy for insomnia (CBT-I)

 directly addresses both our thoughts and behaviors. It is a type of talking therapy that focuses on the idea that how we think, our habits, and our emotions are all linked and influence one another. We can ease mental suffering by challenging our thoughts, changing our habits, and accepting our feelings. CBT-I allows us to do that and more.

To get more information about hyperarousal insomnia and use 

What is hyperarousal, how does it cause insomnia, and how do you treat it? Learn all about hyperarousal insomnia and CBT-I treatment with Dawn.

Hyperarousal Insomnia Definition, Symptoms, Treatment | Dawn Health

Hyperarousal insomnia: Definition, Symptoms, and Treatment

'You never realize the value of something until it's gone.' Anyone who has ever had trouble sleeping can understand how valuable a good night’s sleep is.

Although getting a good night's sleep may be easy for some, the reality is very different for others. The problem is only compounded when the same medication that is supposed to help you sleep causes many sleepless nights.

If you are having trouble sleeping after discontinuing your sleep pills, you may be suffering from rebound insomnia. Read on to learn precisely what it is, why it happens, and what you can do about it.

 is defined as difficulty sleeping following the abrupt discontinuation of commonly prescribed sleep medications, such as short or intermediate-acting benzodiazepine hypnotic drugs. The ease with which you fall asleep depends upon an intricate balance between neurotransmitters and chemicals in the brain.

Sleep medications temporarily tilt its balance in favor of pro-sleep neurotransmitters. For instance, 

, a class of Food and Drug Administration (FDA) approved drugs, induce sleep by enhancing the effect of a neurotransmitter known as gamma-aminobutyric acid (GABA) in the brain and spinal cord.

This, though, does not come without a cost. As you continue to use sleeping pills, your brain adapts to increased levels of these neurotransmitters, which is why you need to continually increase the dose to fall asleep. Further, when you stop taking these pills, the levels of pro-sleep neurotransmitters drop sharply, and with your brain used to higher than normal levels, rebound insomnia ensues. This process, known as 

, is also seen in alcohol and drug users.

Examples of Benzodiazepines, and other sleep medications, 

Rebound insomnia can last from anywhere from a 

. The duration depends upon your susceptibility to withdrawal and the half-life and dose of the medication. The half-life of a drug is an indirect measure of the time for which it is active in the body. Sleeping medications with shorter half-lives tend to cause

, but fortunately, the effect is short-lived. On the other hand, higher doses of insomnia medication can lead to severe and prolonged rebound insomnia.

 than other forms of insomnia, such as acute insomnia and transient insomnia. Not only that, it's also associated with poorer quality of sleep going forward. This is because chemical imbalances in acute and transient insomnia are marginal and temporary. In contrast, the chemical imbalance is not only disproportionate but rebound insomnia is also associated with 

 in the central nervous system (CNS), which take longer to reverse.

‘Prevention is better than cure,’ is a sentence health professionals swear by and not without good reason. Thus, unsurprisingly, the best way to evade rebound insomnia is by avoiding sleeping medications altogether.

Give it time and let your body adjust to not having to rely on medications to sleep. Try to have a consistent wake-up time to aid your natural sleep drive in getting you back on track.

If, however, you are already taking sleeping pills, it's vital that you do not 

 their use abruptly. Gradually tapering the dose under professional supervision can help you prevent rebound insomnia. Cognitive Behavioral Therapy can also help.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

 technique that can help you overcome insomnia and stay on track as you stop relying on sleeping pills to sleep. It is the best alternative to continuing to take sleeping pills.

CBT-I uses talking therapy that focuses on the idea that how we think, our habits, and our emotions are connected and influence one another. By challenging your thoughts, changing habits, and being more accepting of feelings, it can help you through the withdrawal phase as you discontinue your sleeping medication.

To learn more about rebound insomnia and how to counteract the effects of weaning off of sleeping medication with 

What is rebound insomnia? How long does rebound insomnia last? Read on to learn how to treat insomnia from abruptly stopping your sleep medication.

What is rebound insomnia? How long does it last? Read on to learn how to treat insomnia from abruptly stopping your sleep medication.

Rebound Insomnia: Definition, How Long it Lasts, Treatment | Dawn Health

Rebound insomnia

Your tired, sleepy body hits the bed and fifteen minutes later you’re wide awake. Alert. Anxious. Your anxiety about not being able to sleep deepens. You hear the neighbor's dog bark and feel your heart beating in your chest. You hear the faint whine of an electric motor and nervously fixate on it. The day’s worries replay in your mind.

Three hours later you look at the clock. It’s 2 AM.  You’re still not asleep and now the anxiety keeping you awake feeds a raging inferno of 

hyperarousal within your neurobiological and psychological systems

What is the link between anxiety and insomnia?

 It’s normal to feel anxious in response to certain stressors in your life, as long as that anxiety does not interfere with daily functioning for 

. The reason anxiety keeps you awake is because your brain’s security alert system is trying to protect you. When your brain feels your safety is compromised, it will opt for alertness over sleep, because in evolutionary terms there’s no point in sleeping well if you’re about to be devoured by a predator with big teeth.

The effect of this hyperarousal manifests differently in different people. Some struggle to sleep, no matter how tired they are. Others doze off, but wake up soon after and repeat this stop-start cycle throughout the night. Many lie awake for hours every night. Very often insomniacs get so desperate that 

So how do you convince your brain that you’re safe? How do you signal to your brain that it is prudent to switch off the hyperarousal and let the biologically unbreakable, adenosine-fueled sleep drive do its work?

overactive neurobiological and psychological systems

 The sleep drive is fueled by adenosine, which builds while you’re awake.  The moment you take a nap, you start draining some of that adenosine from your sleep tank. Try to keep that tank as full as possible during the day by not napping.

Set and stick to a fixed sleep wake-up time.

  Make sure you wake up at the same time every morning. You have an internal master clock called the circadian rhythm. The clock creates a cycling rhythm that makes you feel tired or alert at regular times of the day and night.  The good news is you can train your clock to follow a particular sleep-wakefulness rhythm by getting up at the same time every morning. Your internal clock responds well to this discipline and, with time, it adjusts to the behavioral changes you initiate.

Create a sleep runway before you go to bed

. Staying in full work mode and coming in to land with screeching tires is not a good strategy. Your mind requires a wind-down period before you go to sleep. Listen to soothing music because it makes you feel good. Read a fiction novel, work on a puzzle, or draw because you enjoy these activities. However, it is vital you do these things without any goal orientation. The moment you do something because you think it’s going to help you sleep, you’re defeating the purpose. Deliberately trying to relax and avoiding adrenaline put your brain on high alert.

 People with sleep anxiety disorder primarily fear the consequences of NOT sleeping. So how do you counter that? By acting as though you don’t care. When bedtime arrives, do not put in any effort to fall asleep. Let go of safety behaviors—all the obsessive things you do to calm yourself before getting under the covers, like getting the Sleepzilla eye mask and ear plugs ready and putting on your special sleep socks. These safety behaviors send a message to your brain that sleep is a big deal. The only way to stop your brain from getting the message, is to change your behavior.

Go for Cognitive Behavioral Therapy for Insomnia

 teaches people different ways of thinking, behaving, and reacting to anxiety-producing and fearful objects and situations. The American College of Physicians recently identified cognitive behavioral therapy for insomnia (CBT-I) as the 

. It improves sleep outcomes and reduces the risks associated with reliance on hypnotics.

 can help you overcome your anxiety and get a good night’s sleep. The Dawn app specifically connects you with CBT-I specialists and uses daily lessons to alleviate the anxiety that causes insomnia.

Learn how to cure your anxiety-related insomnia by 

Can't sleep due to anxiety? Learn how to sleep better despite anxiety keeping you awake with Dawn Health's guide on sleeping when you're feeling anxious.

Can't sleep due to anxiety? Learn how to sleep better despite anxiety keeping you awake with Dawn Health's guide on how to go to sleep when you're feeling anxious.

Can't Sleep Due to Anxiety? | Anxiety and Sleep | Dawn Health

How to go to sleep when you're feeling anxious

If you can’t remember the last time you had a good night’s sleep and you find yourself tossing and turning until the early hours of the morning, you are not alone. Insomnia is the most common sleep disorder, and some studies suggest that it may affect 

. When neglected, insomnia can have long-lasting effects on physical and mental health. It can be caused by several factors, including stress, medication, and an irregular sleep schedule. Researchers have identified three 

Chronic (difficulty sleeping for at least 3 nights a week, lasting for at least three months)

 proposes that predisposing, precipitating, and perpetuating factors contribute to chronic insomnia. 

 may include things that are out of our control, like genetics; it is important to note that, although there is not much that can be done about predisposing factors, they usually cannot cause insomnia on their own. 

can be classified as the short-term or serious stressors that lead to the first few restless nights, such as fighting an illness like a bad cold or a traumatic experience. 

 are those habits that are developed as a result of precipitating factors to cope with the first days or weeks of sleepless nights.

Depending on the severity, insomnia can be treated in a variety of ways. For example, a person with 

 can usually find relief if they adjust their sleeping schedule or eliminate distractions before bedtime. For more severe cases of 

, doctors may prescribe antidepressants, hypnotics, or benzodiazepines. The most common medications used are SSRIs (selective serotonin reuptake inhibitors) such as Citalopram, Fluoxetine, Paroxetine, and Sertraline. Prescribing these medications for insomnia is often ineffective and has long-term side effects.

If you’re interested in CBT-I to treat your chronic insomnia, please 

Why do doctors prescribe antidepressants for insomnia?

Doctors may prescribe antidepressants for insomnia because they tranquilize the brain for a short period of time and balance the chemicals that are responsible for regulating mood. However, as many patients discover, the effects of antidepressants are short-lived, as they don’t treat the root cause of insomnia and instead focus only on the symptoms.

What’s more, the antidepressants prescribed for depression (selective serotonin reuptake inhibitors and tricyclic antidepressants) have a 

In the first weeks, antidepressants may also cause significant changes in behavior, including depressive and suicidal thoughts, especially in patients under the age of 25.

Alternatives to prescription medication for insomnia

If you have had an unpleasant experience with antidepressants, or you want to avoid the side effects linked to antidepressants, there are cures for insomnia without drugs. These non-pharmacological methods can help you restore regular sleeping patterns without the side effects while targeting the cause of the problem, not just the symptoms:

 has shown that up to 83% of people who engage in regular exercise report better sleep quality.

. Over-the-counter antihistamines used to treat allergies have sedative properties that induce drowsiness, and that can help patients with acute and transient insomnia fall asleep faster.

. A scheduled meditation routine helps to change how you relate to stress and worry, which will implicitly help with sleep. Structured relaxation techniques, such as progressive muscle relaxation, diaphragmatic breathing, and yoga, will allow for you to improve on how you deal with stress and worry.

Why CBT-I may be the best treatment for insomnia

CBT (Cognitive Behavioral Therapy) is a form of talking therapy that focuses on the idea that how we think, our habits, and our emotions are connected and influence one another. By challenging our thoughts, changing habits, and being more accepting of feelings, we can alleviate mental suffering. This modern approach to psychotherapy has been clinically proven to treat 

, such as anxiety, depression, PTSD, eating disorders, and substance abuse; according to the American Academy for Sleep Medicine, the American College of Physicians, and the European Sleep Research Society, it can also be effective in treating insomnia.

Cognitive Behavioral Therapy for Insomnia

) focuses on the thoughts, feelings, and behaviors that maintain insomnia, such as worrying that you’re not getting enough sleep before going to bed, or being frustrated that lack of sleep may be causing you health issues. The goal of CBT-I is to help you go to bed without these feelings of anxiety and frustration and fall asleep effortlessly, just like a person who doesn’t have insomnia. In clinical trials, 80% of people with insomnia who have undergone CBT-I reported better sleep in the end.

Dawn is a safe, step-by-step, evidence-based program that uses CBT-I to transform your sleep and regain your ability to sleep naturally. Backed by scientific research and many 

, Dawn offers a personalized sleep plan, tracks your sleep each night, and puts you in touch with a sleep coach who answers your sleep-related questions and keeps you accountable.

To learn more about how to effectively treat your insomnia without medication and why Dawn is the right choice for you, please fill out this 

 to start your journey to a restful night’s sleep!

Curing chronic insomnia without drugs is entirely possible. Read about various ways to overcome your insomnia without prescription medication.

Curing chronic insomnia without drugs is entirely possible. Read about various ways to overcome your insomnia without prescription medicine.

Cures for Insomnia Without Drugs | Dawn Health

Ways to overcome insomnia without antidepressants

Short-term sleep problems are common. Most of us can relate to having nights where sleep just won't come. Here's some basic advice to cut down on those sleepless nights drastically.

1. Get out of bed at the same time each morning.

Your body needs sleep like it needs food and water. The longer you go without food and water, the more your body will crave it. Sleep works precisely the same way—the longer you are awake, the stronger your drive for sleep will get.


 by waking up at the same time each morning. Allowing yourself to be awake for long enough is the most crucial step to improving sleep.

2. Don't go to bed until you are sleepy, and get out if you can't sleep. Use the bed and bedroom for sleeping only.

When you toss and turn in bed and can't fall asleep, you get stressed and frustrated. Experience this enough, and there is a chance you start to associate the bed and bedroom with these emotions.

You can avoid this by making sure you are sleepy when you get to bed. If you have been trying to sleep for a while and find yourself getting frustrated, get out of bed and do something else before trying again.

Every minute you are awake, you build your sleep drive. If you nap, your drive becomes weaker, and it will be harder for you to fall asleep in the evening. Short naps under 20 minutes can be OK for some. Experiment with this and see what works for you.

Caffeine is excellent for waking you up in the morning, but if you drink coffee in the afternoon, your ability to fall asleep will be significantly reduced. This is caused by the way caffeine blocks a sleep-promoting hormone in your brain called Adenosine. People's sensitivity to caffeine varies, and some get rid of the caffeine faster than others.

Alcohol might help you fall asleep faster, but research has shown that alcohol affects your sleep quality by suppressing REM sleep. Alcohol also has the negative effect that it will make you sleep lighter and frequently wake you up.

When people really struggle with sleep and have done so for a while, sleep hygiene advice is often not enough. If you have already employed many of the steps described here with little success, the American Academy for Sleep Medicine, The American College of Physicians, and the European Sleep Research Society recommend cognitive behavioral therapy for insomnia (CBT-I). 

Check out our top 5 tips for getting the most out of your sleep and reducing short-term sleep problems.

5 Must-Know Sleep Wellness and Sleep Hygiene Tips | Dawn Health

5 Must-Know Tips for Better Sleep Hygiene and Wellness


For years, Cognitive Behavioral Therapy (CBT) has been the gold standard for treating insomnia. CBT techniques for insomnia have been proven to work in numerous clinical trials and are more effective than medication.
The American Academy for Sleep Medicine, the American College of Physicians, and the European Sleep Research Society all recommend CBT for insomnia (CBT-I) as first-line treatment.

CBT is a form of therapy that was initially developed as a treatment for depression. The Cognitive in CBT refers to mental activity, such as thoughts, beliefs, memories, images or values. The behavioral part includes all the things we do on a daily basis. This can be things you do with others or things you do alone.
CBT saw it's beginning when the American psychiatrist Aaron T. Beck (and others) noticed a pattern of thinking that was common for many clients with depression. Not very impressed with the result of traditional therapies, they wanted to address these issues with a more straightforward and direct approach. And so Cognitive Behavioral Therapy was born.


A core principle in CBT is that our emotional reactions and behaviors are influenced by how we think about ourselves, others, and the world around us. Humans have a great capacity for thinking, but that requires time and energy. Most of the time, we take mental shortcuts and react to events that happen without giving them much thought. These shortcuts, or cognitive biases, often lead us to interpret and process information inaccurately.
If you ask two people to give a presentation on something they are both knowledgeable about, you might get two different reactions. One is hesitant and suggests someone else. The other immediately and enthusiastically agrees. It's the exact same situation. So why do they react so differently?


CBT explains that this difference in emotional reactions and behaviors comes from different ways of thinking about the situation. One thinks he might start to shake and others will notice. The other one thinks that this is a good opportunity to share his knowledge.

Changing what you do is often the most powerful way of changing how you think and feel about something. The behavioral part in CBT is about testing new behaviors and learning what happens when you gain new experiences.
If you always avoid giving presentations, you will never experience a successful one. Your negative thoughts about yourself in that situation will never change. A common unhelpful belief that people have when speaking to a crowd is that they will get anxious, start to shake, and the audience will see that as a sign of weakness.
To target the cognition that shaking is a sign of weakness, CBT uses something called a behavioral experiment. In these kinds of experiments, the goal is to get real experiences about what happens if you shake and if it's true that other people will react negatively to this. A typical behavioral experiment might be to videotape yourself talking in front of a crowd. When viewing the video afterward, try to notice the level of shaking and what reaction the group had to this. Most likely, you will see that your shaking was barely noticeable, and those who were listening didn't react at all.

The CBT triangle (putting it all together)

Therapy involves changing how you feel about something. Whether it is to achieve a goal or to stop being anxious or sad — it's all about changing emotions. Now, this is hard to do directly. We have little control over our emotions; they will pop up whether you like it or not. CBT aims to change how you feel about something through our thoughts (cognitions) and behaviors.

CBT has been used by thousands of therapists and millions of patients from all over the world since the 1960s. Since then, different CBT approaches have been developed for a wide range of problems, and research has repeatedly shown its effectiveness. It’s common to talk about CBT as a specific kind of therapy, but in reality there are many models of cognitive behavioral therapies.
One of these models is CBT for insomnia which this guide is about.

CBT helps with unhelpful thinking and behavior, but how it is used to treat insomnia isn’t obvious. To illustrate how insomnia is caused by cognitions and how CBT can help you sleep, let’s use two fictional people who represent two different ways of experiencing sleep. Meet George who has insomnia and Susan who doesn’t.

George has had insomnia for a long time. Over the years he’s had many sleepless nights, spent tossing and turning and waiting for sleep. George's insomnia has been getting worse lately and he frequently wakes up in the middle of the night and can't get back to sleep. For the last couple of months, he hasn’t been getting more than 4 or 5 hours of sleep each night.

Susan has always been a good sleeper. She always falls asleep within fifteen minutes of going to bed and wakes up feeling refreshed. Susan doesn’t really think much about sleep, it’s just something that happens when she goes to bed.

Why does George have insomnia and not Susan?

What may not be obvious but separates George from Susan, is that they have very different beliefs about sleep. They experience precisely the same situation each night; they both go to bed and try to sleep. Their thoughts and feelings in this situation, are very different.
George worries that it's going to be another night of sleeplessness and that he will be dead tired at work the following day. He thinks about how a lack of sleep might damage his body and wonders if he will ever sleep well again. The minute his head hits the pillow, he's wide awake. His mind races and he starts feeling anxious and upset. He's exhausted but can't seem to fall asleep. After spending quite a bit of time unsuccessfully trying to sleep, he pulls out his phone and listens to a podcast to distract himself. He finally falls asleep a few hours before he has to get up for work.
Susan goes to bed and doesn't think much about it at all. She is fast asleep fifteen minutes after she turns off the lights.

George’s sleep problems started when the company he was working for experienced financial trouble and had to downsize. He worried about losing his job and not being able to afford rent. George found that he became preoccupied with thoughts of worry most of the day and even more as nighttime approached and it was time to sleep. He tried, as most do when facing problems in life, to think his way out of it. After a while, George noticed that his sleep was getting worse. It frequently took a long time to fall asleep, and he often woke up multiple times every night.
Fortunately, George didn’t lose his job. The company is now doing fine, and he doesn’t worry about it anymore, but he’s still struggling with sleep.
George’s story is typical when it comes to insomnia. It's common that some initial stressful life event sets it off, but the problems persist even when the stressor has resolved. It is notable that the event that causes insomnia in the first place varies, but when insomnia has been established, people begin to behave and think the same way.

CBT does not concern itself much with what initially caused George's insomnia. Instead, it focuses on the thoughts, feelings, and behaviors that maintain it. In George's case, we can see a pattern of him worrying a lot about sleep and the consequences of not getting enough. After a while, he starts to associate the bed with feelings of frustration and anxiety.
When George's thoughts constantly revolve around sleep and the consequences of him not getting enough, his mind will interpret this as a threat. The brain's threat detection system doesn't make the distinction between thinking about a threat or actually experiencing one. It does what it’s supposed to do and tells the body to get prepared for the threat.
When the brain signals the body to get ready, the body reacts immediately. It goes into a state of arousal where the main goal is to be prepared to handle anything. Arousal is, in many ways, a state that is the opposite of sleeping. Your heart beats a little faster, your breathing starts to increase in frequency. Pupils dilate, and you are more vigilant. Because the brain believes you are in danger, you go into a mild form of fight-or-flight mode where your senses are heightened, and muscles are ready to spring into action.
The most convincing and compelling way of learning that a previously held belief is false is experiencing the opposite. George has the view that he has to put in a lot of effort to get to sleep. A goal of CBT for insomnia is going to sleep without thinking or worrying too much about it. We want George to be more like Susan and experience falling asleep without effort, and as a result, learn that he can fall asleep easily without thinking too much about it. To help people get this valuable experience, CBT for insomnia uses something called sleep restriction.

When people who struggle with sleep hear about sleep restriction the first time, they immediately think it's counterintuitive. Why should you restrict your sleep when you want more of it?
To answer this question, we need to learn about sleep drive. Sleep drive is the force that makes you sleepy when you have been awake for a long time. To measure how strong your sleep drive is, the body uses a hormone called adenosine. The moment you wake up in the morning, the body starts producing adenosine. When the brain detects high enough levels, it starts shutting off wake-promoting areas in the brain, and you get sleepy. The longer you stay awake, the more adenosine the body produces, and your sleep drive increases.

The name sleep restriction is a bit misleading, and it could just as well have been called time-in-bed restriction or sleep consolidation. Sleep restriction is, in essence, spending less time in bed to increase the sleep drive. When starting with sleep restriction, you determine how much sleep you have been getting in total for the last week. If you have been getting an average of about 7 hours of sleep each night, you get an initial 7 hour window of time to sleep. This means that if you have to get up at 8 am each morning, you shouldn't try to sleep before 1 am. The 7 hours between 1 am and 8 am is called your sleep window. Whether you sleep or not in your window is not important, at least in the beginning. What is important is that you do not sleep outside of your sleep window.

It's important to note that sleep restriction isn't meant as something you should do for the rest of your life. It also gets a little easier as you progress. Your sleep window will increase when you stop spending so much time trying to sleep.
As previously mentioned, behavioral changes that lead to new experiences are amongst the most powerful methods for bringing about change in cognitions. By restricting your time in bed and building your sleep drive, you will strengthen the forces that make you sleep, so they are stronger than the forces that keep you awake. Sleep restriction aims to get you to experience what it's like to sleep without worrying about it. You gain confidence in your body's ability to go to sleep on its own without you having to think about it all.

Many people who suffer from insomnia report that they have a much easier time falling asleep on their couch, for example, than in their bed. This can be explained with something called classical conditioning, which we are all receptive to.
Conditioning is a form of learning by associating one thing to another. An example of being conditioned is when you hear a particular song and the song makes you happy because you associate the song with a good time.
When we have regular problems falling asleep and or staying asleep, we begin to associate the bed and trying to sleep with negative emotions. We get frustrated, angry, sad and anxious about not sleeping. We toss and turn, and despite being tired, we can't get to sleep. The bed and bedroom can become a stimulus that we associate with negative feelings.
CBT for insomnia uses stimulus control to break the negative association between trying to sleep and negative feelings. A common way to employ stimulus control is by having a set of guidelines or rules for sleep.

Some examples of rules for stimulus control:

The bed should only be used for sleeping (and sex).

What is CBT-I? Learn all about cognitive behavioral therapy, how it treats insomnia, CBT triangle, and more with Dawn’s guide to CBT for insomnia.